Abstract 12707: Automatic Remote Ischemic Preconditioning Procedure Reduced Contrast Medium-induced Acute Kidney Injury and Reperfusion Arrhythmias in Patients with St-elevation Myocardial Infarction
Background: Several studies reported that remote ischemic preconditioning (RIPC), an intervention in which brief ischemia of one tissue or organ protects remote organs from a sustained episode of ischemia, reduces the myocardial damage in patients undergoing PCI or CABG. It, however, is hard to perform RIPC in acute setting because it requires additional man power. In this study, we have developed device to perform RIPC automatically, and conducted to assess the impact of RIPC on clinical outcomes in patients with acute ST-elevation MI (STEMI).
Methods: Consecutive 116 patients with a suspected STEMI were randomly assigned to receive primary PCI with or without RIPC before emergent PCI. We assessed the resolution of ST elevation, peak value of CPK, and the incidences of reperfusion arrhythmias and of contrast induced nephropathy (CIN).
Results: Twenty-five patients were excluded because they did not meet inclusion criteria. Baseline characteristics were almost similar. There were no significant difference in the frequency of ST resolution >50% between RIPC group (n=43) and non-RIPC group (n=48) (RIPC vs. non-RIPC; 33 patients (77%) vs. 29 patients (67%), P=0.1). The peak CPK values and the incidences of both reperfusion arrhythmias after PCI and CIN were significantly lower in the RIPC group than non-RIPC group (2636±1979 vs. 3687±2873 IU/L; P=0.047, 5 patient (12%) vs. 16 patients (33%); P=0.01, and 5 patients (13%) vs. 17 patients (35%), P=0.008, respectively). The changes of estimated glomerular filtration rate (eGFR) within 48 hours after PCI was lower in RIPC group than in non-RIPC group (0.49±16.9mL /min/1.73m2 versus -10.3±17.2mL /min/1.73m2; P=0.006).
Conclusions: Our device can perform RIPC smoothly in emergency setting among patients with STEMI. RIPC before emergent PCI can reduce cardiac complications, arrhythmias and contrast medium-induced acute kidney injury (CI-AKI), associated with STEMI.
- © 2013 by American Heart Association, Inc.